International Hypnosis Research Institute - Chiropractic

The United States Chiropractic Workforce: An alternative or complement to primary care?

Wed, 23 Jan 2013 16:34:00 -0500

BACKGROUND: In the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation's primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians. METHODS: We used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types. RESULTS: According to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson's correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians. CONCLUSION: These findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access. Chiropr Man Therap. 2012 Nov 21;20(1):35. Davis MA, Mackenzie TA, Coulter ID, Whedon JM, Weeks WB.

Use of Complementary Therapies in Cardiovascular Disease.

Wed, 09 Jan 2013 16:34:00 -0500

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) treatments in outpatients with cardiovascular disease and their interest in future use. The increasing popularity of CAM therapies highlights the need to explore their use among patients with cardiovascular disease. Data were collected with a prospective, point-of-care, anonymous, 17-question survey about basic medical information and previous use and interest in the future use of dietary supplements and other CAM interventions among patients undergoing outpatient cardiology evaluation at a Midwestern tertiary care center. The survey was completed by 1,055 patients (655 men, 351 women; mean age 63.5 years) of whom 98.1% were white. Of these, 36.8% had cardiac symptoms for >10 years, 48.2% had coronary artery disease, and 82.5% reported use of CAM therapies. Of these patients, 75.4% reported using dietary supplements, 31.5% chiropractic therapy, 23.9% mind-body therapies, and 19.2% massage. Only 14.4% had discussed the use of CAM treatments with their physicians. The top 4 treatments used for cardiac symptoms were relaxation techniques, stress management, meditation, and guided imagery. Also, 48.6% were interested in participating in a future clinical trial of an alternative treatment. The great majority of patients seen in current practice use CAM therapies, and a large proportion expressed an interest in participating in research with CAM therapies. In conclusion, research directed with an integrative approach to cardiovascular care might prove beneficial when designing future studies. Am J Cardiol. 2012 Nov 24. pii: S0002-9149(12)02287-4. doi: 10.1016/j.amjcard.2012.10.010. Prasad K, Sharma V, Lackore K, Jenkins SM, Prasad A, Sood A. Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: prasad.kavita@mayo.edu.

Complementary and alternative medicine usage by patients of a dental school clinic.

Sun, 30 Dec 2012 17:48:00 -0500

Assistant Professor, Department of Family Dentistry, The University of Iowa College of Dentistry, Iowa City, Iowa Private Practice of General Dentistry, Ankeny, Iowa Professor, Department of Pediatric Dentistry and Director of the Biostatistics Unit for the College of Dentistry Professor and Head, Department of Family Dentistry Biostatistician, Dows Institute for Dental Research, The University of Iowa College of Dentistry, Iowa City, Iowa Professor, Department of Internal Medicine, The University of Iowa College of Medicine, Iowa City, Iowa Associate Professor and Director of Dental Pharmacy, The University of Iowa College of Dentistry, Iowa City, Iowa. This pilot study investigated the prevalence and specific reasons for usage of complementary and alternative medicine (CAM) among patients of a dental school clinic. Four hundred and two patients completed a 30-page survey on CAM usage. A higher rate of CAM usage was found in this dental school clinic population than rates previously reported in a general population. More than three-quarters (76.1%) of the respondents reported using at least one CAM treatment in the past 12 months; 93.3% reported using at least one CAM treatment at some time in their lives. High rates of chiropractic use were found in this population. Tooth pain was the most frequently reported dental condition motivating CAM use. About 10% of dental school clinic patients use topical oral herbal and/or natural products to treat dental conditions, most frequently for preventive/oral health reasons or for tooth pain. Spec Care Dentist. 2012 Sep;32(5):177-183. doi: 10.1111/j.1754-4505.2012.00273.x. Spector ML, Fischer M, Dawson DV, Holmes DC, Kummet C, Nisly NL, Baker KA.

Chiropractic Use, Health Care Expenditures, and Health Outcomes for Rural and Nonrural Individuals W

Sun, 23 Dec 2012 17:45:00 -0500

Arthritis is considered the leading cause of disability among adults in the United States today and contributes substantially to the rising cost of health care. Residents of rural areas are especially affected. The purposes of this article are to describe chiropractic use by rural and nonrural individuals with arthritis and to identify differences in other health care use and health status by those using chiropractic care plus conventional care or conventional care alone. A longitudinal cohort from panel 12 (N = 12440) of the Medical Expenditure Panel Survey spanning 2007 to 2008 was selected for this study to represent changes in health care expenditures and use and outcomes throughout this period. The population was stratified by self-reported physician-diagnosed arthritis and rural status and compared across demographics, health status, and health care use and expenditures, including use of chiropractic services plus conventional care or conventional care alone. Twice as many rural people with arthritis had 1 or more visits with a doctor of chiropractic compared with nonrural persons with arthritis. More rural chiropractic users with arthritis reported their perceived health status as excellent, very good, or good compared with nonrural chiropractic users with arthritis and to rural people with arthritis who reported no chiropractic visits. Health care expenditures for other physician services were higher among rural chiropractic users with arthritis than nonrural users with arthritis. Differences in chiropractic use were observed between rural and nonrural individuals with arthritis. More studies are needed to investigate these differences and the impact on health care use and expenditures and outcomes of individuals with arthritis. J Manipulative Physiol Ther. 2012 Aug 27. Enyinnaya EI, Anderson JG, Merwin EI, Taylor AG. Postdoctoral Research Fellow, Center for the Study of Complementary and Alternative Therapies, School of Nursing, University of Virginia, Charlottesville, VA.

Conservative management of a 31 year old male with left sided low back and leg pain: a case report.

Sun, 16 Dec 2012 17:42:00 -0500

This case study reported the conservative management of a patient presenting with left sided low back and leg pain diagnosed as a left sided L5-S1 disc prolapse/herniation. A 31-year-old male recreational worker presented with left sided low back and leg pain for the previous 3-4 months that was exacerbated by prolonged sitting. The plan of management included interferential current, soft tissue trigger point and myofascial therapy, lateral recumbent manual low velocity, low amplitude traction mobilizations and pelvic blocking as necessary. Home care included heat, icing, neural mobilizations, repeated extension exercises, stretching, core muscle strengthening, as well as the avoidance of prolonged sitting and using a low back support in his work chair. The patient responded well after the first visit and his leg and back pain were almost completely resolved by the third visit. Conservative chiropractic care appears to reduce pain and improve mobility in this case of a L5-S1 disc herniation. Active rehabilitative treatment strategies are recommended before surgical referral. J Can Chiropr Assoc. 2012 Sep;56(3):225-32. Howell ER. Ashbridge's Health Centre, 1522 Queen St. East, Toronto, ON M4L 1E3. E-mail: dremilyhowell@hotmail.com .

A replication of the study 'Adverse effects of spinal manipulation: a systematic review'

Sun, 09 Dec 2012 17:39:00 -0500

To assess the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events of SMT as reported by Ernest (J Roy Soc Med 100:330--338, 2007). Replication of a 2007 Ernest paper to compare the details recorded in this paper to the original source material. Specific items that were assessed included the time lapse between treatment and the adverse event, and the recording of other significant risk factors such as diabetes, hyperhomocysteinemia, use of oral contraceptive pill, any history of hypertension, atherosclerosis and migraine. The review of the 32 papers discussed by Ernest found numerous errors or inconsistencies from the original case reports and case series. These errors included alteration of the age or sex of the patient, and omission or misrepresentation of the long term response of the patient to the adverse event. Other errors included incorrectly assigning spinal manipulation therapy (SMT) as chiropractic treatment when it had been reported in the original paper as delivered by a non-chiropractic provider (e.g. Physician).The original case reports often omitted to record the time lapse between treatment and the adverse event, and other significant clinical or risk factors. The country of origin of the original paper was also overlooked, which is significant as chiropractic is not legislated in many countries. In 21 of the cases reported by Ernest to be chiropractic treatment, 11 were from countries where chiropractic is not legislated. The number of errors or omissions in the 2007 Ernest paper, reduce the validity of the study and the reported conclusions. The omissions of potential risk factors and the timeline between the adverse event and SMT could be significant confounding factors. Greater care is also needed to distinguish between chiropractors and other health practitioners when reviewing the application of SMT and related adverse effects. Chiropr Man Therap. 2012 Sep 21;20(1):30. Tuchin P.

A Literature Review of Pediatric Spinal Manipulation and Chiropractic Manipulative Therapy...

Sat, 17 Nov 2012 17:47:00 -0500

Full title: A Literature Review of Pediatric Spinal Manipulation and Chiropractic Manipulative Therapy: Evaluation of Consistent Use of Safety Terminology. The purpose of this study was to perform a literature search to identify relevant studies on pediatric spinal manipulation and chiropractic manipulative therapy and to assess if safety terminology was consistent with the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). A literature search was performed in PubMed using the following terms: spinal manipulation pediatric, chiropractic safety pediatric, and manual therapy safety pediatric. PubMed was searched from inception to April 2012 with no language limitations. The international standards included the terminology of the World Health Organization on side effects, adverse reactions, adverse events and the ICH guideline templates that were adapted for manual therapy for this study. Of the 9 relevant articles identified in this study, 3 reported methodology for classifying safety incidents, and all 9 used safety terminology (adverse effects or adverse events). However, terminology was not used consistently. Most of the articles identified in this literature review did not use terminology consistent with the standards established by the ICH when reporting on safety incidents following pediatric spinal manipulation or chiropractic manipulative therapy. More efforts should be taken to include consistent terminology for studies of spinal manipulation and chiropractic manipulative therapy for children. J Manipulative Physiol Ther. 2012 Aug 27. Marchand AM.

Precompetition manipulative treatment and performance...

Mon, 22 Oct 2012 17:44:00 -0500

Full title: Precompetition manipulative treatment and performance among virginia tech athletes during 2 consecutive football seasons: a preliminary, retrospective report. One of the goals of providing manipulative treatment such as osteopathic manipulative treatment (OMT) is to restore maximal, pain-free movement of the musculoskeletal system and to enhance neuromuscular function. Anecdotally, some athletes have reported that their athletic performance improves after manipulative treatment. To develop preliminary data to gain more understanding about the association between precompetition manipulative treatments provided to Division I football players and their athletic performance during each game for 2 consecutive football seasons. The study design was a retrospective cohort study. Participants were football athletes at Virginia Polytechnic Institute and State University (Virginia Tech). Board-certified osteopathic physicians who were trained in osteopathic manipulative medicine and sports medicine performed OMT and determined the type of OMT techniques used and the spinal segments treated. One chiropractor provided chiropractic manipulative therapy. Prior to each game, the athletes who elected to receive precompetition manipulative treatment (ie, OMT or chiropractic manipulative therapy) underwent a focused physical examination and received manipulative treatment on the basis of clinical findings. After each game, the coaching staff "graded" the players by using a standard coaching algorithm. Offensive players received a percentile score (0 to 100) and defensive players received a numeric score (>30 was considered "very good"). A total of 1976 manipulative treatments were provided to 115 football players in 2 consecutive football seasons. Sixty-two offensive players received 985 manipulative treatments, and 53 defensive players received 991 manipulative treatments. Treatments were applied to the affected regions of the spine: cervical, thoracic, lumbar, and sacral sections. Mean (standard deviation) performance scores were 67.8% (22.8%) and 11.1 (9.9) points among offensive and defensive players, respectively. The correlation coefficients between the numbers of the manipulative treatments and the performance scores were 0.107 (P=.407) among the offensive players and 0.218 (P=.117) among the defensive players. Precompetition manipulative treatment was positively associated with improved performance among both offensive and defensive Virginia Tech football players. Although the associations between these 2 factors were relatively small and not statistically significant, we found positive correlations in performance of the offensive and defensive players. J Am Osteopath Assoc. 2012 Sep;112(9):607-15. Brolinson PG, Smolka M, Rogers M, Sukpraprut S, Goforth MW, Tilley G, Doolan KP. Associate Dean for Clinical Research, VCOM, 2265 Kraft Dr, Blacksburg, VA 24060-6360. pbrolins@vcom.vt.edu.

Precompetition manipulative treatment and performance...

Sat, 20 Oct 2012 17:44:00 -0500

Acute sciatica and progressive neurological deficit secondary to facet synovial cysts: A report of t

Mon, 15 Oct 2012 17:43:00 -0500

To describe two patients with lumbar facet synovial cysts causing sciatica and progressive neurological deficit. A 52-year-old female with bilateral sciatica and a neurological deficit that progressed to a foot drop; and a 54-year-old female with worsening sciatica and progressive calf weakness were seen at a major tertiary care centre. Diagnostic imaging studies revealed the presence of spinal nerve root impingement by large facet synovial cysts. Activity modification, gabapentinoid and non-steroidal anti-inflammatory medications were unsuccessful in ameliorating either patient's symptoms. One patient had been receiving ongoing lumbar chiropractic spinal manipulative therapy despite the onset of a progressive neurological deficit. Both patients eventually required surgery to remove the cyst and decompress the affected spinal nerve roots. Patients with acute sciatica who develop a progressive neurological deficit while under care, require prompt referral for axial imaging and surgical consultation. Primary care spine clinicians need to be aware of lumbar facet synovial cysts as a possible cause of acute sciatica and the associated increased risk of the patient developing a progressive neurological deficit. J Can Chiropr Assoc. 2012 Sep;56(3):173-8. Arthur B, Lewkonia P, Quon JA, Street J, Bishop PB. Combined Neurosurgical and Orthopaedic Spine Program, Vancouver General Hospital, Division of Spine, Department of Orthopaedics & I.C.O.R.D. (International Collaboration on Repair Discoveries), University of British Columbia, Vancouver, Canada.

Acute sciatica and progressive neurological deficit secondary to facet synovial cysts: A report of t

Sat, 13 Oct 2012 17:43:00 -0500

Use of a computer interviewing system in a chiropractic clinic during periodic patient reassessment.

Mon, 16 Jan 2012 16:21:00 -0500

OBJECTIVE: The purpose of this study was to investigate whether a computer interviewing system (CIS) could be used as part of the periodic patient reassessment process, if patients and practitioners perceived that the CIS enhanced communication, and if the CIS could be used to identify patients with possible anxiety and/or depression. METHODS: An observational method was used, whereby the CIS was used to augment the usual patient reassessment routine in a chiropractic clinic. One clinic in the Dundee region, with 3 chiropractors, collected information from 60 patients using a CIS directly before the patient treatment session. The patients were then asked to rate whether they had disclosed new information relative to their care, if they felt better prepared, or if it had helped them to formulate questions. The chiropractors reported whether the interview transcript was useful, if it helped to identify communication issues, and if it had altered the treatment session. RESULTS: The doctors of chiropractic rated the interview transcript as useful for 83% of patients, they altered the treatment session for 20% of patients, and the CIS helped to identify communication difficulties for 13% of patients. The chiropractors were surprised by the Hospital Anxiety and Depression Scale results for 23% of patients. The patients were positive about the inclusion of the CIS, with 42% saying that they disclosed new information and 33% saying that they felt better prepared for the session with the chiropractor after having used the CIS. The CIS was acceptable to 90% of patients. CONCLUSIONS: The inclusion of the CIS at this one clinic appeared to be a useful addition to the periodic patient reassessment process and was perceived to be an efficient media to evaluate Hospital Anxiety and Depression Scale scores. J Manipulative Physiol Ther. 2011 Sep;34(7):468-75. Hands KA, Cashley M, McWilliam R, Steen L. PhD Student, School of Computing, University of Dundee, Dundee, Scotland, UK. katrina.hands@tiscali.co.uk

Enlightenment by chiropractic's developing mode.

Mon, 26 Dec 2011 16:18:00 -0500

Traditional Chinese spinal manipulative therapy (TCSMT) and Chiropractic are similar in treating related with spinal disease, but they keep different characteristics of themselves. Although Chiropractic's "Subluxation" and TCSMT's "Jin Chu Cao and Gu Cuo Feng" theory have not be widely recognized, yet Chiropractic has already have official cooperation with WHO,and has launched "WHO Basis of Chiropractic Training and Security Guide" which would promote the project further research. Comparatively, TCSMT has mature theoretical system and satisfactory clinical effectiveness, but it's hard to global spreading formally and legally. By means of cogitation of the TCSMT'S basic theories and clinical applications, this paper aims to analyze the inadequacy aspects of it, and hope to borrow some Chiropractic's advantage to TCSMT's global spreading. And I wish this paper could be helpful for relative doctors and researchers. Zhongguo Gu Shang. 2011 Aug;24(8):662-6. Wang HH, Zhang MC, Zhan HS. Hospital Affiliated to Shanghai University of TCM, Insititue of Orthopedics and Traumatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.

Immunization Status of Adult Chiropractic Patients in Analyses of National Health Interview Survey.

Mon, 19 Dec 2011 16:17:00 -0500

OBJECTIVE: Two recent studies that examined National Health Interview Survey data reported divergent findings regarding the propensity of adult chiropractic users to receive seasonal influenza immunization. Although one study found a statistically significant negative association between chiropractic use and influenza vaccination, another found that chiropractic users were significantly more likely to be vaccinated. The purpose of this study is to extend previous works by delving more deeply into recent data to identify adult chiropractic users at high risk and high priority for vaccination against influenza and pneumococcal disease. METHODS: We used data from the 2007 National Health Interview Survey in an attempt to replicate previous methodologies and further examine vaccination among adult chiropractic users (age =18 years) who, according to the Center for Disease Control and Prevention guidelines, should receive influenza and/or pneumococcal vaccination. We used complex survey design methods to make national estimates and used logistic regression to determine if having used chiropractic care predicted vaccination. RESULTS: We found major methodological differences between the prior studies. In our analyses, we found that chiropractic users were significantly less likely than nonusers to have received the pneumococcal vaccine, and we found no significant difference between chiropractic users and nonusers relative to having received the seasonal flu vaccine. CONCLUSIONS: Methodological differences in previous studies that investigated the association between chiropractic care and adult vaccination likely explain divergent findings reported in the literature. Future studies should consider these differences. J Manipulative Physiol Ther. 2011 Sep 22. Smith M, Davis MA. Adjunct Faculty, National University of Health Sciences, Pinellas Park, FL.

A survey of accessibility and utilisation of chiropractic services...

Mon, 12 Dec 2011 16:16:00 -0500

Full Title: A survey of accessibility and utilisation of chiropractic services for wheelchair-users in the United Kingdom: What are the issues? BACKGROUND: People with physical disabilities experience barriers to healthcare across all services despite a legal and moral obligation to the contrary. Complementary medicine is considered as supplementary to conventional care and integration of these approaches is essential to achieve optimal care. This paper explores the utilization of chiropractic services and practitioner experiences of treating wheelchair-users which appears under-reported. METHODS: A 20 item questionnaire was posted to 250 randomly selected chiropractors registered with the General Chiropractic Council. Follow-up questionnaires were sent 7 days after the initial return date. Quantitative data were subjected to frequency analysis. RESULTS: The response rate was 64% (n = 161). The majority (66%) of chiropractors had been in practice less than 10 years and were practice owners (50%). Fifty-two percent of chiropractors sampled had treated a patient in a wheelchair in the previous 5 years. The majority (87%) had treated between 1 and 5 such patients. Patients with multiple sclerosis, stroke and cerebral palsy most commonly presented for treatment. The majority of patients' presenting complaint was musculoskeletal in origin, primarily for pain control. Only 13% of respondents worked in a fully accessible clinic. Impracticality of alterations was the most common reason for inaccessibility. CONCLUSIONS: Wheelchair-users seem to be an underserved patient group in relation to chiropractic services. Chiropractic management is primarily utilised for pain control in patients with physical disabilities in which mobility may be improved or maintained. Co-management of wheelchair-users with GPs appears to be desirable in order to achieve optimal patient care however more research is required regarding the efficacy of chiropractic treatment for a range of disabling conditions. Physical access was identified as a key barrier to accessing care. Chiropr Man Therap. 2011 Sep 13;19(1):20. McKay ND, Langworthy J. Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, UK. naomi.chiro@gmail.com.